| NPI | 1629237748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL 8375) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL AA9599397) |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2008-06-04 |